Author + information
- Received December 4, 2017
- Revision received January 26, 2018
- Accepted February 12, 2018
- Published online December 3, 2018.
- Raquel P. Amier, MDa,
- Martijn W. Smulders, MDb,
- Wiesje M. van der Flier, PhDc,
- Sebastiaan C.A.M. Bekkers, MD, PhDb,d,
- Alwin Zweerink, MDa,
- Cornelis P. Allaart, MD, PhDa,
- Ahmet Demirkiran, MDa,
- Sebastiaan T. Roos, MDa,
- Paul F.A. Teunissen, MD, PhDa,
- Yolande Appelman, MD, PhDa,
- Niels van Royen, MD, PhDa,
- Raymond J. Kim, MD, PhDe,
- Albert C. van Rossum, MD, PhDa and
- Robin Nijveldt, MD, PhDa,∗ ()
- aDepartment of Cardiology, VU University Medical Center, Amsterdam, the Netherlands
- bDepartment of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- cDepartment of Epidemiology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, the Netherlands
- dDepartment of Radiology, Maastricht University Medical Center, Maastricht, the Netherlands
- eDuke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Robin Nijveldt, Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
Objectives This study investigated the prevalence of silent myocardial infarction (MI) in patients presenting with first acute myocardial infarction (AMI), and its relation with mortality and major adverse cardiovascular events (MACE) at long-term follow-up.
Background Up to 54% of MI occurs without apparent symptoms. The prevalence and long-term prognostic implications of previous silent MI in patients presenting with seemingly first AMI are unclear.
Methods A 2-center observational longitudinal study was performed in 392 patients presenting with first AMI between 2003 and 2013, who underwent late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) examination within 14 days post-AMI. Silent MI was assessed on LGE-CMR images by identifying regions of hyperenhancement with an ischemic distribution pattern in other territories than the AMI. Mortality and MACE (all-cause death, reinfarction, coronary artery bypass grafting, and ischemic stroke) were assessed at 6.8 ± 2.9 years follow-up.
Results Thirty-two patients (8.2%) showed silent MI on LGE-CMR. Compared with patients without silent MI, mortality risk was higher in patients with silent MI (hazard ratio: 3.87; 95% confidence interval: 1.21 to 12.38; p = 0.023), as was risk of MACE (hazard ratio: 3.10; 95% confidence interval: 1.22 to 7.86; p = 0.017), both independent from clinical and infarction-related characteristics.
Conclusions Silent MI occurred in 8.2% of patients presenting with first AMI and was independently related to poorer long-term clinical outcome, with a more than 3-fold risk of mortality and MACE. Silent MI holds prognostic value over important traditional prognosticators in the setting of AMI, indicating that these patients represent a high-risk subgroup warranting clinical awareness.
- acute myocardial infarction
- cardiovascular magnetic resonance
- late gadolinium enhancement
- unrecognized myocardial infarction
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 4, 2017.
- Revision received January 26, 2018.
- Accepted February 12, 2018.
- 2018 The Authors